Abstract
ObjectiveTo investigate the safety and efficacy of camrelizumab in combination with nab-paclitaxel plus S-1 for the treatment of gastric cancer with serosal invasion.MethodTwo hundred patients with gastric cancer with serosal invasion who received neoadjuvant therapy from January 2012 to December 2020 were retrospectively analyzed. According to the different neoadjuvant therapy regimens, the patients were divided into the following three groups: the SOX group (S-1 + oxaliplatin) (72 patients), SAP group (S-1 + nab-paclitaxel) (95 patients) and C-SAP group (camrelizumab + S-1 + nab-paclitaxel) (33 patients).ResultThe pathological response (TRG 1a/1b) in the C-SAP group (39.4%) was not significantly different from that in the SAP group (26.3%) and was significantly higher than that in the SOX group (18.1%). The rate of ypT0 in the C-SAP group (24.2%) was higher than that in the SAP group (6.3%) and the SOX group (5.6%). The rate of ypN0 in the C-SAP group (66.7%) was also higher than that in the SAP group (38.9%) and the SOX group (36.1%). The rate of pCR in the C-SAP group (21.2%) was higher than that in the SAP group (5.3%) and the SOX group (2.8%). The use of an anti-PD-1 monoclonal antibody was an independent protective factor for TRG grade (1a/1b). The use of camrelizumab did not increase postoperative complications or the adverse effects of neoadjuvant therapy.ConclusionCamrelizumab combined with nab-paclitaxel plus S-1 could significantly improve the rate of tumor regression grade (TRG 1a/1b) and the rate of pCR in gastric cancer with serosal invasion.
Highlights
Gastric cancer is the fifth most common malignant tumor worldwide and the third leading cause of cancer-related death [1, 2]
The inclusion criteria were as follows: gastric adenocarcinoma confirmed by gastroscopy and pathology before surgery; clinical stage: cT4, lymph node N1 to N3, nondistant metastasis (M0); ECOG score 0-2; and blood index, liver and kidney function, and cardiopulmonary function indicating that patients could tolerate chemotherapy or surgery
There was no significant difference in the rate of Tumor regression grade (TRG) grade (1a + 1b) between the C-SAP group (39.4%) and the SAP group (26.3%) (P > 0.05), but the rate in these two groups was higher than that in the SOX group (18.1%) (P < 0.05)
Summary
Gastric cancer is the fifth most common malignant tumor worldwide and the third leading cause of cancer-related death [1, 2]. Surgical resection remains the only radical treatment available for patients with nonmetastatic gastric cancer. Because the recurrence rate remains high, multidisciplinary therapy, including neoadjuvant chemotherapy, has gradually become important for the treatment of advanced gastric cancer. In Europe and the Americas, docetaxel, oxaliplatin, fluorouracil, and leucovorin (the FLOT regimen) have become the standard neoadjuvant chemotherapy for advanced gastric cancer (CT2/N+M0) [3, 4]. Cisplatin, and fluorouracil or capecitabine (ECF/ECX regimen), the FLOT regimen has shown superiority in terms of pathological responses and overall survival outcomes. In China, the results of the RESOLVE trial [5] showed that the SOX regimen increased the overall survival rate of advanced gastric cancer (cT4aN+M0/cT4bN×M0) patients and the 3-year disease-free survival rate
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